Consumer-directed health plans (CDHPs) entered the market around 2000-01 in response to limitations of traditional managed care plans63 and are increasingly being used by employers to try to contain costs without sacrificing healthcare quality. The idea is to provide consumers with the information and incentives to take costs into account when they make healthcare choices. Typically CDHPs combine catastrophic insurance coverage with health spending accounts. Although CDHPs give employees greater choice of benefits and providers, they expose them to greater financial risk.64 Compared with those in more comprehensive plans, CDHP enrollees miss more care and are less satisfied with their plan;furthermore, although CDHP enrollees are more cost-conscious, they still pay higher out-of-pocket costs.65 Despite a growing literature on CDHPs, little is known about attitudes towards CDHPs and factors affecting, plan selection among individuals at high risk of mental health services use, or how CDHPs affect use and especially quality of mental health services. One of our closest, most longstanding (11+ years) community partners, United Behavioral Health (UBH), has identified the impact of CDHPs on quality of mental health care as a policy-relevant research topic of strong interest to UBH's clients. We propose to build on our collaboration with UBH researchers to study a "natural experiment" among one of their client companies. In January 2005, all employees of a large, national company (henceforth referred to as the "company") were moved from a traditional health insurance system to one in which they could choose only between three types of CDHPs. We propose to use a mixed methods approach to understand the influence of mental health on the CDHP choices and satisfaction of employees affected by this move. The quantitative analyses will address the question of "who" selects which plan and the qualitative analyses will complement the findings from quantitative analyses by informing the question of "why" employees select particular plans and their experiences using that plan.